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This Month in Archives of General Psychiatry
April 2001

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2001;58(4):321. doi:10.1001/archpsyc.58.4.321

Huestis et alArticle showed, for the first time in humans, the ability of the first selective cannabinoid CB1 receptor antagonist, SR141716, to block the psychological and physiological effects of marijuana. The findings of this study establish an important role for the CB1 receptor in mediating the effects of smoked marijuana in humans. The antagonist was well tolerated, suggesting that CB1 receptor antagonists may offer a novel therapeutic approach for conditions possibly related to dysfunction of the endogenous cannabinoid system (eg, schizophrenia, dementia, and marijuana dependence).

A commentary by D'Souza and KostenArticle is included.

Using 15OH2 positron emission tomography, script-guided mental imagery, and multiple control conditions, Kilts et alArticle found that conditioned drug craving was associated with the activation of a network of limbic, paralimbic, and striatal brain regions in men dependent on cocaine. By furthering the understanding of how the cocaine-dependent human craves cocaine, these results provide new insights on how conditioned craving can be reduced in future attempts to treat cocaine addiction.

A commentary by GawinArticle is included.

George et alArticle used functional magnetic resonance imaging to measure brain activity while 10 nontreatment–seeking adults with alcoholism and10 age- and gender-matched social drinkers viewed alcohol specific cues after a sip of alcohol. The patients with alcoholism had increased activity in the left prefrontal cortex and thalamus. These patients also had greater cravings for alcohol. This work may help understand alcoholism pathogenesis.

Harper et alArticle measured rhythms of activity and core-body temperature in patients with Alzheimer disease and frontotemporal degenerative dementia (including Pick disease and corticobasal ganglionic degeneration). Their findings suggest that the circadian system may be affected by these illnesses in different ways.

In a large cohort, Malaspina et alArticle found a clear monotonic increase in schizophrenia risk related to advancing paternal age that accounted for more than a quarter of all cases of schizophrenia. This finding may have public health implications and offers a new paradigm for investigating candidate genes for schizophrenia.

Applying cholecystokinin-tetrapeptide to patients with panic disorder and healthy controls, Wiedemann et alArticle report that pretreatment with atrial natriuretic peptide (ANP) decreases the provoked panic symptoms. The concomitant pituitary–adrenocortical activation and sympathetic stimulation were inhibited by ANP. This study indicates that ANP has anxiolytic effects and curtails stress reactions.

Jarrett et alArticle performed the first randomized trial comparing cognitive therapy (CT) with and without a continuation phase in patients with recurrent major depression who responded, unmedicated, to acute-phase CT. Adding 8 months of continuation phase-CT (C-CT) reduced relapse significantly more than the control phase (no C-CT). After C-CT was discontinued, patients were followed up for 16 more months. C-CT reduced both relapse and recurrence significantly more than control treatment.

Nagin and TremblayArticle studied early predictors of the developmental course of physical aggression in boys primarily to distinguish those who were persistently aggressive from ages 6 to 15 years (persisters) from those who were comparably aggressive at age 6, but whose physical aggression subsequently declined (decliners). Of the many parental and psychological factors tested, only 2 characteristics distinguished these 2 groups. The persisters were more likely than the decliners to have mothers who began childbearing as teenagers and who were poorly educated.

Simon et alArticle examined continuity of medication use and frequency of follow-up visits among patients starting antidepressant treatment in health maintenance organization psychiatry or primary care clinics. The shortcomings frequently noted in primary care practice (premature medication discontinuation, infrequent follow-up visits) were also common among psychiatrists' patients. Efforts to improve treatment adherence and provide adequate follow-up care are needed in specialty as well as primary care practice.